Your "normal," or what you expect to feel like, has somehow taken a downturn, and you need to feel like "yourself" again. Of the remaining prescription testosterone pills on the market, most are simply not very effective. First, most prescription testosterone pills are toxic to the liver. The problem with many oral testosterone medications is twofold. Much of this is the same — prescription or OTC, ingesting testosterone through the stomach is ineffective or harmful. If you value your liver (and your life), OTC testosterone supplements are something to stay away from. They can’t increase your testosterone directly, and the same is true for these OTC testosterone supplements.
With oral forms of testosterone, including sublingual testosterone, not only do we see a rapid spike in testosterone levels, but we also see them plummet relatively quickly. Some patients are not candidates for traditional low testosterone therapy and may benefit from topical (AndroGel, Testim, Axiron, Fortesta) or hCG therapy. This allows us to put and keep your testosterone levels in the "sweet spot," so to speak. To stay within the "optimal" range for your body, you’ll need an injection on day 7 to restore levels and prevent them from dropping out of the desired range. The Low T medication that medical providers have preferred for decades is called testosterone cypionate, delivered by means of intramuscular injection.
Not all of this means that bioidentical hormones are bad, but the marketing of bioidentical testosterone products is definitely questionable. The real question should be, "Will my body recognize and react to the FDA-approved medication that you prescribe in the same way it would react to naturally occurring hormones? The fact is, testosterone injections, topicals (gels/creams), and pellet implants all utilize an FDA-approved formula that is not "bioidentical" — "bioidentical" is something of a hormone myth.
Hormones are your body’s communication network, and excess estrogen (in proportion to testosterone) signals the body to develop more female characteristics, which may include the development of breast tissue in men. Research indicates that gynecomastia is usually caused by a hormone imbalance between male hormones (testosterone) and female hormones (estrogen or estradiol), with the ratio between the two as the determining factor. The simple answer is, "Too much estrogen," but it’s not just the simple amount of female hormones present in your system that leads to gynecomastia. Very few studies (if any) have found that Testosterone Replacement Therapy for people with legitimately low testosterone is dangerous or harmful, either to the heart, to cholesterol levels, or to any other bodily function.
It’s impossible to forget to take this form of Low T medication since it’s an implant. These testosterone replacement pellets were originally conceived to help with patient compliance — compliance basically means taking the medication the way you’re supposed to take it. In summary, there’s just too much up and down going on to feel comfortable with the safety of this form of Low T medication, which is why we never recommend sublingual testosterone at Testosterone Centers of Texas. Results for absorption of sublingual testosterone also vary widely from person to person. Sublingual testosterone is also only available from compounding pharmacies, which, given the low level of regulation of compounding pharmacies in the U.S., means that it is very hard to guarantee the quality of the drug that you receive. Quick spikes are typically accompanied by rapid conversion of testosterone into estradiol, which as you probably know, is a type of estrogen. Similar to the topicals above, it’s convenient and is absorbed the quickest of all forms.